Patient Vesha Gilbert says she learned a lesson after having to make an emergency visit for tooth pain: She’s going to floss and brush regularly. Dentist Bianca Hillers works on Gilbert’s decayed molar at Denver Health’s Webb Clinic.

Laressa Watlington/Colorado Public News

Patient Vesha Gilbert says she learned a lesson after having to make an emergency visit for tooth pain: She’s going to floss and brush regularly. Dentist Bianca Hillers works on Gilbert’s decayed molar at Denver Health’s Webb Clinic.

Nineteen-year-old Vesha Gilbert’s toothache had become so unbearable, she ended up where no one wants to be: Sitting in a dentist’s chair, cringing at the thought of having her decayed back molar pulled.

“I’m scared, but I’m glad I’m here,” she said. “It feels like somebody’s knocking me on the side of my mouth with a hammer, like, constantly, and it goes in and out like every five seconds.”

Gilbert had rushed to an urgent-care clinic for relief from her throbbing mouth, but doctors there couldn’t do anything, except send her to the dentist to have her tooth pulled.

Gilbert is not alone. Last year, Coloradans with dental complaints went to emergency rooms 39,000 times – even though they could have been pain-free if they had simply stayed on top of regular cleaning and maintenance, according to the Colorado Dental Association.

Making it worse, ER visits for dental problems cost $350 to $650, far more than a routine dental visit, according to a Colorado Public News price survey. And usually, the physicians can’t fix the tooth. They treat the infection and pain – and then send patients to a dentist.

Gilbert said that she, of all people, should never have ignored her teeth. She has dental insurance through her job at Walmart, and her mom is a dental hygienist.

“My mom always told me, and I was like ... ‘Mom, you know I’m grown, so ... ’ I was just being careless, I guess, not brushing and flossing.” Vesha says she wasn’t willing to give up sweets to save her teeth. Instead, she’s giving up a tooth.

Other patients who end up in the ER have no dental insurance and can’t afford to pay a dentist out of pocket, so they ignore tooth decay until it’s too late.

Numbers from the latest Colorado Health Access Survey, conducted by the Colorado Health Institute, show that 40 percent of Coloradans do not have dental insurance. The same percentage skipped going to the dentist last year.

Findings from the telephone survey of 10,352 households include:

Sixty percent of people older than age 65 have no dental insurance. (Medicare doesn’t cover dental care.)

More than half of Hispanics surveyed have no dental insurance. And 55 percent of Hispanic kindergartners in the state were found to have a cavity, compared to 32 percent of white children.

For many rural Coloradans, often there is no dentist nearby.

Dr. Chris Colwell, Denver Health Medical Center’s director of emergency medicine, said toothaches have become common in his ER.

“We, as the last resort, are seeing something pretty much every day, and almost every shift during the day,” he said.

Colwell says many of the patients he sees are on the weekends, when many dental offices are closed. He cited one patient who came in on a Sunday morning with infected gums, and no cash.

“The dentist wanted money up front,” Colwell said. So the man waited, and finally had to go to the ER.

Ignoring gums and teeth can lead to much more serious problems than a mouthful of pain and plaque, said Katya Mauritson, oral-health unit director for the Colorado Department of Public Health and Environment.

“Last year, in another state, a healthy 24-year-old man went to the ER with tooth pain and he didn’t have medical or dental insurance,” Mauritson said. “He wound up only being able to fill the pain pills because that’s all he had money for. And then he wound up dying,” as the infection progressed to a brain abscess, she said.

Because people usually can’t see dental disease until it worsens, it is often called a “silent epidemic.” Prevention is key, says Ken Peters, president of the Colorado Dental Association. “We can’t drill our way out of this issue.”

Annual visits to the dentist also may catch early signs of nutritional deficiencies and even detect the presence of some cancers, the association said.

Dr. Louis Sullivan, a former secretary of Health and Human Services, is on a personal campaign to improve dental health and stop the unnecessary visits to ERs, which reached 830,000 in 2009 and cost well over $100 million nationally. “We have a major problem that can be preventable. We need to turn this around.”

Recently, officials have begun to act. State programs have helped get many low-income children insured. Gov. John Hickenlooper recently called dental health one of the state’s “10 winnable battles.” He has proposed adding funds for coverage of some adults on Medicaid, the government health insurance program for low-income people.

Last year, a bill to provide dental care to pregnant women on Medicaid had bipartisan support, but died in the year-end fight in the Legislature over civil unions.

With millions of taxpayer dollars covering many unneeded emergency room visits for toothaches, dental health is beginning to move off the back burner.

Vesha Gilbert says after this painful and expensive experience, she’ll be regularly flossing and brushing – and listening to her mother.

“I’m glad I’m taking care of this so that I can go back to work ... because a toothache keeping you from working ... that’s horrible.”

Colorado Public News, a nonprofit news organization, reports on issues of statewide interest. It partners with Colorado Public Television 12, Denver?s independent PBS station.

Rural residents impacted most

People living in rural parts of the state tend to skip the dentist more often and have the toughest time finding dental care – in part because nine of the Colorado’s 64 counties have no resident dentist.

These counties are Bent, Cheyenne, Crowley, Costilla, Hinsdale, Gilpin, Jackson, Kiowa and San Juan, where Silverton is the county seat.

To compound the problem, a dozen counties do not have a dental hygienist who could perform routine checkups and cleanings. Most of these counties have populations of 3,000 people or fewer.

“That’s not a lot of people to support a practice, when you consider only half of them will even go to a dentist,” said Ken Peters, president of the Colorado Dental Association.

The association is working on a plan to send young dentists to Colorado’s underserved areas. Presently, 2˝ times more dentists graduate every year than there are jobs to be filled.

Further complicating the access issue: Residents of rural areas are less likely than urbanites to carry dental health insurance. The Colorado Health Access Survey found nearly 60 percent of those who live in the southwest corner of the state go without dental coverage, compared to 29 percent along the Front Range. In the other three corners, half don’t have dental insurance. People who live in rural Colorado often pay out of pocket for any oral health problems, and are also likely driving a long way to get care.

Katya Mauritson, oral health director for Colorado Department of Public Health and Environment, said the rural residents also miss out on another dental advantage: Their water may not contain the cavity-fighting additive fluoride.

“One of the biggest public-health interventions of the 20th century is water fluoridation,” she said.